Real-world experience with rezafungin for the treatment of biofilm-forming <i>Candida</i> infections

Biofilm eradication remains a significant challenge in clinical practice and contributes substantially to healthcare costs. Medical devices serve as a common substrate for biofilm formation and are implicated in a considerable proportion of invasive candidiasis cases. Rezafungin, a next-generation echinocandin, exhibits broad-spectrum fungicidal activity against <i>Candida</i> spp. and <i>in vitro</i> studies have confirmed its efficacy against <i>Candida</i> biofilms. A literature review up to July 2025 was conducted, including PubMed, Embase, Web of Science, and gray literature, focusing on the real-world use of rezafungin for device-related and other biofilm-associated <i>Candida</i> infections. Real-world data may suggest its clinical effectiveness in managing complex fungal infections frequently associated with biofilms, such as implant-associated infections, endocarditis, or osteoarticular infections, particularly in co-morbid patients. Among the 18 reviewed cases, mostly coming from Europe and the United States, a successful outcome was reported in 83.3% of patients after a median treatment duration of over 3 months, with no serious drug-related adverse events reported. Although these findings should be interpreted cautiously, given the limited sample size and heterogeneity of cases, they support rezafungin as a potential therapeutic option for biofilm-associated fungal infections.